Healthcare Provider Details

I. General information

NPI: 1407412216
Provider Name (Legal Business Name): JUDY ARLENE MARSYLA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2019
Last Update Date: 05/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1338 COMMERCE AVE STE 303
LONGVIEW WA
98632-3726
US

IV. Provider business mailing address

1827 SUSAN AVE
LONGVIEW WA
98632-3325
US

V. Phone/Fax

Practice location:
  • Phone: 360-748-4480
  • Fax:
Mailing address:
  • Phone: 360-425-4231
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN0138448
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: